by B Zedeck
discoloration of the skin due to methemoglobinemia. The city
toxicologist and the health department eventually determined
that salt shakers in a food establishment visited by all of the men
contained sodium nitrite instead of table salt, sodium chloride.
Tolerance to inhalants can develop with frequent use, and
withdrawal symptoms include sleep disturbance, irritability,
jitteriness, sweating, nausea and vomiting, fast heart rate, and
hallucinations or delusions. Withdrawal can last one month or
longer, and the relapse rate is high.
Inhalants 107
FORENSIC ISSUES
In 1962, California enacted the first known law against glue
sniffing. By 1968, 13 states and 29 counties passed anti-glue
sniffing legislation prohibiting the inhalation or drinking of
products such as glue or adhesive cement for the purpose of
becoming intoxicated or otherwise altering mental functions.
Although not regulated under the Controlled Substances Act
(CSA), many state legislatures have attempted to deter youth
from buying legal products containing inhalants. As reported by
the National Conference of State Legislatures, by the year 2000,
38 states had adopted laws preventing the sale and/or distribu-
tion to minors of various products commonly abused as inhal-
ants, with penalties of fines or incarceration for offenders.
In one particular case, a man was stopped for driving while
intoxicated (DWI). A breathalyzer test revealed a blood alco-
hol concentration (BAC) of 0.20%. The driver claimed that
he had consumed only three beers within a four-hour period
and that the BAC reading was incorrect. He also claimed that
he had been working all day with furniture refinishing prod-
ucts containing volatile chemicals such as toluene, xylene,
acetone, and hexane, and that these chemicals interfered with
the breath test. Testimony dealt with the effects of these inhal-
ants on behavior and coordination, and how they may have
contributed to the defendant’s erratic driving. However, these
inhalants do not alter a breathalyzer test, and thus the jury was
convinced that the 0.20% reading indicated that the defendant
was lying about the number of drinks he had consumed. The
driver was found guilty of DWI.
SUMMARY
Inhalants are volatile substances that produce mind-altering
effects ranging from euphoria to hallucinations. Effects on brain,
108 Forensic Pharmacology
heart, liver, and kidneys are associated with inhalant use, includ-
ing sudden sniffing death, which can occur within minutes of
using highly concentrated amounts of an inhalant. Tolerance to
inhalants can develop with frequent use, and, although with-
drawal is possible, it occurs infrequently.
Anabolic-
Androgenic
12
Steroids
Anabolic-androgenic steroids (AAS) used as drugs of abuse
include the natural hormone testosterone and its synthetic
derivatives. Not included in this class of drugs are the female
steroid hormones, estrogen, and progesterone, and the cortico-
steroids, such as cortisone and prednisone. More than 150 years
ago, it was discovered that testes played a role in maintaining
male characteristics. Testosterone, isolated from bull testes, was
identified as the active chemical. It soon became evident that
testosterone not only controlled masculinizing (androgenic)
properties but could also induce muscle-building (anabolic)
effects. Since synthetic derivatives of testosterone induce both
anabolic and androgenic effects, this class of drugs is called
anabolic-androgenic steroids.
Recently, two books have drawn attention to the use of ste-
roids by baseball players, and Congress has held hearings on the
extent of steroid use in this sport. The current rules provide for
a 50-game suspension for a first-time steroid user, a 100-game
suspension for a second-time offender, and a lifetime ban from
baseball if tested positive for a third time. A NIDA survey taken
in 2002 indicates that 2.5% of 8th graders, 3.5% of 10th graders,
109
110 Forensic Pharmacology
and 4.0% of 12th graders have used anabolic-androgenic steroids
at least once.18
AAS are Schedule III drugs and are referred to as roids
and juice. Products include Anadrol® (oxymetholone), Oxan-
drin® (oxandrolone), Dianabol® (methandrostenolone, D-bol,
D-ball), Winstrol® (stanozolol), Durabolin® (nandrolone),
Depo®-testosterone (testosterone, Depo-T), and Equipoise®
(boldenone).
PHARMACOLOGY OF STEROIDS
Depending on the AAS, a steroid can be administered either
orally or by injection (Figure 12.1). Testosterone is inactivated
Laws, Politics, and Steroids
The Anabolic Steroid Control Act of 2004 adds steroid pre-
cursor chemicals to the list of controlled substances under
the Controlled Substance Act (CSA). One of the AAS that is
not included on the control ed substance list is dehydroepi-
androsterone (DHEA). DHEA is metabolized into testosterone
in the body. This chemical, exempt under federal law, is sold in
nutrition shops. Senator Orrin G. Hatch of Utah, where many
dietary substance companies exist, managed to convince
enough members of Congress to exclude this chemical from
the list of controlled substances. Although DHEA is available
to the general public, it is unlikely that sports figures will use
it, as it is banned by the International Olympic Committee, the
World Anti-Doping Agency, the National Col egiate Athletic
Association, the National Football League, the National Bas-
ketball Association, and minor league basebal .
Anabolic-Androgenic Steroids 111
in the liver and has little effect if taken orally. Synthetic com-
pounds, which are less readily metabolized, can be given by
mouth, but are usually given in oil by intramuscular injection
and are absorbed slowly. AAS can be detected in urine within
four to six hours after use and, depending on the AAS, for weeks
or months thereafter.
Unlike most drugs discussed in prior chapters, use of AAS
does not result in euphoria. People use these agents for long
periods of time to improve their physical appearance and ath-
letic performance. A metabolite of testosterone, dihydrotestos-
terone, acts in the cell nucleus to synthesize RNA and protein
molecules that result in more efficient use of nitrogen to build
muscle tissue. Individuals using AAS, however, are in dan-
ger of developing a physical and psychological dependence.
Withdrawal results in depressive mood, fatigue, restlessness,
anorexia, insomnia, decreased libido, musculoskeletal pain,
and suicidal tendencies.
Adverse reactions that can occur while taking AAS include
liver toxicity, suicide, delirium, aggression (called “roid rage”),
mood swings, psychosis, premature baldness, and acne. Steroids
can interfere with endocrine function. For males, there is
the
possibility of benign prostatic hypertrophy, testicular atrophy,
sterility, enlargement of breast tissue, and closure of the bone
epiphysis, resulting in shortened growth. For females, the con-
cerns include shrinking of breast size, clitoral hypertrophy,
hirsutism (facial and body hair), and deepened voice. AAS have
been used medically to treat osteoporosis, anemia, breast cancer,
and other diseases.
FORENSIC ISSUES
In one particular case, a man attacked another with a bat.
The man who was attacked took the bat and used it to hit
the attacker, who later died. At the murder trial, the defense
112 Forensic Pharmacology
Figure 12.1 Anabolic-androgenic steroids, such as Depo®-
Testosterone, are often injected directly into muscle tissue. In teens,
steroid use can slow or halt bone growth and damage the heart,
kidneys, and liver.
Anabolic-Androgenic Steroids 113
wanted to introduce evidence that the deceased used large
amounts of AAS, and autopsy results showed that the deceased
had an enlarged heart consistent with his steroid use. Such use
of AAS by the attacker would have made for a strong argument
that rage played a role and that the defendant had no choice but
to defend himself. The defense, however, was barred because
of legal technicalities from introducing this evidence and tes-
timony. Without the evidence of AAS use, the defendant was
found guilty of manslaughter.
SUMMARY
Anabolic-androgenic steroids (AAS), which are analogs of the
male hormone testosterone, are used among athletes and body-
builders. AAS alter the hormonal systems of males and females,
and induce many adverse effects. In addition to the sex-related
changes, violent behavior and psychological dependence can
also occur. The use of AAS in professional sports as well as in
high school sports has aroused considerable attention.
The Future
of Forensic
13 Pharmacology
In the first chapters of this book, we discussed the fields of
pharmacology and toxicology, how these sciences are applied
to the legal system, the role of the forensic scientist, and some
of the analytical tools used to detect the presence of chemi-
cals in bodily fluids and tissues. Drugs of abuse were chosen
to illustrate practical applications of forensic pharmacology,
since these drugs are often involved in legal matters. In order
to establish a causal link between exposure to a chemical and
an eventual outcome, the forensic scientist must understand
the pharmacokinetics, pharmacodynamics, and effects of
each chemical under study. Only then can one draw an accu-
rate conclusion as to causality. Each of the eight drug chap-
ters provided actual cases to illustrate how such information
played a role in the resolution of the case. It is now of interest
to look ahead and envision the role of forensic pharmacology
in the future.
New chemicals are synthesized constantly. Also, many
pharmacologically active chemicals continue to be found
in plant life and sea life, and it can be expected that these
114
The Future of Forensic Pharmacology 115
resources will continue to provide new material. Some of the
newly discovered chemicals will have antianxiety properties
or be used to treat pain, and such drugs, acting in the central
nervous system (CNS), may lead to drug abuse. In addition
to new chemicals, people are constantly modifying existing
drugs of abuse and synthesizing new drugs for recreational
purposes. Consequently, either to maintain the habit of tak-
ing these drugs or because of their effects on behavior, coor-
dination, and judgment, users may engage in criminal activity
or cause injury to themselves or others. The forensic scientist
needs to be knowledgeable of new legal and illegal drugs and
of their pharmacological and toxicological effects.
Pharmacokinetic and pharmacodynamic studies lead to a
greater understanding of chemical interactions at the molecu-
lar level and may identify specific receptors for drug activity.
With more specific knowledge of how a drug works, it may
become easier to more accurately establish what effects are
actually caused by a particular drug. Thus, studies in these
two areas of pharmacology will always be necessary.
As discussed earlier, forensic pharmacology and toxicol-
ogy are not limited to the study of drugs of abuse or poisons.
These fields of science also have a growing role in the legal
system to help resolve civil issues related to chemical exposure
and cancer causation, medical malpractice as a result of drug
interactions, and product liability issues.
CHALLENGES FOR THE FUTURE
To identify the presence of new drugs, forensic scientists
will always need to develop new analytical techniques. In
addition, analytical techniques with greater specificity and
sensitivity will continue to be developed for existing drugs.
116 Forensic Pharmacology
Reporting false-positive results may send an innocent person
to prison, so everything possible must be done to avoid such
an outcome. Assays with enhanced sensitivity to detect both
parent compound and metabolites will allow for detection
of drugs over longer periods of time and for more accurate
determination of when an individual was first exposed to a
chemical.
Today, everyone is aware of terrorist activity. A well-known
terrorist attack involving chemicals occurred in 1995 with the
release of the nerve gas sarin in the subway systems of Tokyo,
resulting in the death of 12 people and injury of many more.
Should chemicals again be used for terrorist activity, foren-
sic pharmacologists and toxicologists may be called upon
to analyze bodily samples in order to identify the chemical,
determine its mechanism of action, and propose antidotes
and preventive measures.
Forensic science is an exciting and rewarding field of work. A
forensic scientist is at times a scientific detective and at times a
teacher, instructing the judge, attorney, and jury, and helping
to promote justice. Enrollment in forensic science programs
will continue to increase as new programs are established at
colleges and forensic science courses are introduced at the
high school level. As more industries, sports organizations,
and agencies involved with supervision of children monitor
their personnel for drug abuse, additional forensic scientists
and laboratory facilities will be needed.
To assure that the best technology is available and that
personnel are qualified, forensic science laboratories should
undergo accreditation processes with periodic proficiency
testing. This will assure some uniformity in procedure among
different laboratories, and provide assurance that samples are
analyzed correctly and data are interpreted accurately.
The Future of Forensic Pharmacology
117
Thus, much work lies ahead. As the field of forensic science
advances, forensic pharmacologists and toxicologists will
continue to be integral players in bringing truth to our system
of justice.
14
Solve the Cases!
The following hypothetical scenarios are intended to test your
knowledge of the pharmacology of drugs of abuse and of the
procedures used to resolve cases. The answers are provided at
the end of the chapter.
Case a. ImpaIred drIvIng?
A police officer stops a car that is driving fast and erratically on
a major highway. The driver stumbles slightly when stepping out
of the car. The officer, a trained drug recognition expert (DRE),
notices that the driver’s eyes are bloodshot and the pupils are
dilated. The officer sees an empty beer bottle but does not detect
any unusual odor or see any signs of drugs. The DRE performs
a roadside breath test, which reveals a BAC of 0.02%, and field
sobriety tests, which the driver fails.
What do you suspect caused the erratic driving, and what
additional tests would you suggest be performed?
Case B. Team rIvalry?
Before a big football game, the coach of Team A called in the
squad for a pep talk and breakfast of juice, bagels, and donuts. As
118
Solve the Cases! 119
the teams took the field, the two opposing quarterbacks wished
each other good luck with a Gatorade toast. Fifteen minutes into
the game, the Team A quarterback began acting aggressive, anx-
ious, and hyperactive, and then passed out. Doctors rushed onto
the field and found the quarterback had slightly elevated blood
pressure, heart rate, and respiration, and was sweating and sali-
vating. The quarterback was revived, but stared into space and
was nonresponsive. In the locker room, suspecting an overdose
of drugs, a urine sample was collected. The results were positive
for morphine and one other drug.
How do you explain the presence of morphine? Does the
presence of morphine agree with the signs and symptoms exhib-
ited by the quarterback? What other drug do you suspect was
found?
Case C. goT away wITh IT?
Following a motor vehicle accident, the driver accused of caus-
ing the accident was taken to a hospital, where a urine sample
was obtained. A screening test revealed the presence of benzodi-
